Early results using the Atlantis anterior cervical plate system

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material.</jats:p> <jats:p>The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine.</jats:p> <jats:p>Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which required reoperation and intravenous antibiotic medication. Two cases (2.6%) of anterior screw backout and/or breakage were identified. One patient died of unrelated causes within 3 months of operation.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>These initial results indicate that use of the Atlantis plate system for anterior cervical arthrodesis produces fusion rates and clinical outcomes that are comparable with those obtained using other locking plating systems. It has the unique advantage, however, of providing the surgeon with the choice of fixed, variable, or hybrid screw constructs as a way of tailoring screw angles to individual anatomical/biomechanical needs.</jats:p></jats:sec>

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

“…Mean sagittal Cobb angle was 9°b efore surgery, and 16.9°at last follow-up. Of note, the authors used precountered TMCs and a correction of 8°w as achieved resembling a similar curve correction reported in other series including 2-and 3-level surgeries [6,111]. With instrumented 3-level ACDF and hybrid reconstructions for the correction of postsurgical CK in 10 cases, Steinmetz et al [110] achieved a mean correction of 20°w ith a mean lordosis of 8°.…”

“…The surgical complications in our series encountering only 4-and 5-level anterior fusions are comparable, and even less than compared to similar studies [6,25,77,101,110,111,126]. According to Lee et al, 50% of patients will suffer short-term dysphagia and about 10% have long-term sequelae following ACDFs [63].…”

“…We assessed clinical outcome with modified Odom criteria [6,28,49,84]. Outcome was determined as excellent, good, fair, and poor.…”

“…It serves in foraminal and central decompression as the cord slightly shifts posteriorly, away of the mainly anteriorly situated stenosis [7,112,113]. Oppositively, cervical lordosis is difficult to be reconstructed effectively using large cages or grafts in case of multilevel corpectoEur Spine J (2007) 16:2055-2071 2065 mies, because of the rectangular shape of most current devices or the design of the grafts [6,48,70]. Mean correction in patients with 2-and 3-level corpectomies was 6.8°in our series, resembling a similar value compared to other series [48,52,103], and mainly representing the lordotic shape of currently used ACPs (Fig.…”

“…Posterior fusion was successful in redo surgeries and was recommended for multilevel fusions. Barnes et al [6] reported on 20 patients with 2-or multilevel ACDF, and six with multilevel corpectomies. ACPS with posterior stabilization in eight corpectomy cases resulted in a successful union rate of 93.5%.…”